‘We’re on life support,’ says CEO in charge of St. Paul’s

VANCOUVER, BC.: APRIL 19, 2012 — St’ Paul’s Hospital CEO Dianne Doyle sits in her office in Vancouver, B.C., April 19, 2012. IMAGE FOR USE ONLY WITH ST. PAUL’S PROJECT IN THE PROVINCE. NO OTHER USE PERMITTED.
(Arlen Redekop photo/ PNG)
(For story by [Elaine O’Conner])Arlen Redekop
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VANCOUVER, BC.: APRIL 12, 2012 — St. Paul’s Hospital in Vancouver, B.C., April 12, 2012. The Province Heartbeat Project. IMAGE FOR USE ONLY WITH ST. PAUL’S PROJECT IN THE PROVINCE. NO OTHER USE PERMITTED.
(Arlen Redekop photo/ PNG)
(For story by [Cheryl Chan])
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This rusted gate, currently not in use, is located at the old main entrance to St. Paul’s Hospital.Arlen Redekop
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VANCOUVER, BC.: APRIL 19, 2012 — Bonnie Maples, corporate dir. strategic planning and physical assets at St. Paul’s Hospital in Vancouver, B.C., April 19, 2012. IMAGE FOR USE ONLY WITH ST. PAUL’S PROJECT IN THE PROVINCE. NO OTHER USE PERMITTED.
(Arlen Redekop photo/ PNG)
(For story by [Elaine O’Conner])Arlen Redekop
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VANCOUVER, BC.: APRIL 19, 2012 — Old pump switches are still being used in the basement at St. Paul’s in Vancouver, B.C., April 19, 2012. IMAGE FOR USE ONLY WITH ST. PAUL’S PROJECT IN THE PROVINCE. NO OTHER USE PERMITTED. (Arlen Redekop photo/ PNG) (For story by [Elaine O’Conner])Arlen Redekop
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VANCOUVER, BC.: APRIL 19, 2012 — St. Paul’s Hospital’s Bonnie Maples, corporate dir. strategic planning and physical assets, stands next to an old bath tub which was used by boiler room workers to wash up in Vancouver, B.C., April 19, 2012. IMAGE FOR USE ONLY WITH ST. PAUL’S PROJECT IN THE PROVINCE. NO OTHER USE PERMITTED.
(Arlen Redekop photo/ PNG)
(For story by [Elaine O’Conner])Arlen Redekop
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VANCOUVER, BC.: APRIL 19, 2012 — A can catches the water from a leaky pipe in the basement of St. Paul’s Hospital in Vancouver, B.C., April 19, 2012. IMAGE FOR USE ONLY WITH ST. PAUL’S PROJECT IN THE PROVINCE. NO OTHER USE PERMITTED. (Arlen Redekop photo/ PNG) (For story by [Elaine O’Conner])Arlen Redekop
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VANCOUVER, BC.: APRIL 19, 2012 — Asbestos warning is posted in the basement at St. Paul’s Hospital in Vancouver, B.C., April 19, 2012. IMAGE FOR USE ONLY WITH ST. PAUL’S PROJECT IN THE PROVINCE. NO OTHER USE PERMITTED. (Arlen Redekop photo/ PNG) (For story by [Elaine O’Conner])Arlen Redekop
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VANCOUVER, BC.: APRIL 19, 2012 — Old equipment and chipped paint abound in the basement of St. Paul’s Hospital in Vancouver, B.C., April 19, 2012. IMAGE FOR USE ONLY WITH ST. PAUL’S PROJECT IN THE PROVINCE. NO OTHER USE PERMITTED. (Arlen Redekop photo/ PNG) (For story by [Elaine O’Conner])Arlen Redekop
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If St. Paul’s Hospital were a patient, it would only survive in intensive care.

The hospital, founded in 1894, is proud of its past, but when it comes to infrastructure — including the almost 100-year-old Burrard building, still in use today — that history is not an asset, but a critical liability.

“We’re on life support,” said Doyle, who joined St. Paul’s as an intensive care nurse in 1976 and was appointed CEO in 2006.

“The ability for our electrical system to support new equipment, the ability for us to have adequacy of space in our operating rooms,” all are challenges, she said.

“We have one of our more vulnerable populations, our mental health patients … housed in the oldest part of our building. I don’t think that reflects our commitment to providing excellent care.”

According to a 2011 report, “St. Paul’s is increasingly challenged by the age, condition and configuration of its facilities. Some hospital buildings are nearly a century old and all are at a high risk for system failure; they will not survive an earthquake or other major disaster.”

Critical infrastructure, including elevators, wiring and emergency generators, is listed in “deplorable” condition, and “at risk for cataclysmic failure.”

Wiring shorts, pipes leak and several areas contain hazardous asbestos. Only the Providence building is fully sprinklered. The hospital’s elevators are more than 30 years old and average 40 failures a month. In February 2011, a key electrical conduit failed, plunging the hospital into complete darkness for a few seconds. Luckily, the emergency generators kicked in (they’d failed twice during testing) and it happened late at night when no surgeries were in session.

The event was seen as a wake-up call, and a warning. Shortly after, the government coughed up $1 million for electrical upgrades. Later that year, it funded a $17.2 million upgrade for St. Paul’s elevators and electrical systems.

Doyle is grateful for the funding, but the CEO is working on a permanent solution: a $610-million plan to modernize the hospital, adding a 228,000-square-foot tower on the site of the old Comox building, bringing buildings up to code and creating new patient and research spaces, with the goal of completing work between 2014 and 2020.

Surprisingly, Doyle, a senior executive in health care for 25 years, said her hardest job is not funding a major upgrade, but simply keeping St. Paul’s staff doing their best in a clearly sub-par environment.

“What I don’t want to see is that this progresses to a point where our staff become so distracted by that and so frustrated by needing to work in an environment that is so challenging and doesn’t enable their excellence that they begin to lose hope and begin to lose their focus on excellence … or leave,” she said.

“We don’t want to in any way say to our community that your safety is in jeopardy. The reality, however, is our ability to continue to keep that commitment becomes more and more challenging the longer ... we are expecting our staff and our physicians to deal with very challenging space and facility needs.”

St. Paul’s staff are not alone in bemoaning hospital conditions.

The province’s own facility condition index, compiled in 2003/04, labelled the Burrard, Comox and MacDonald buildings and boiler plant’s seismic risk assessment levels “extreme.” The Comox building was deemed “unsuitable for any occupancy.”

As a result, there are very real concerns about St. Paul’s viability in the event of a natural disaster.

Bonnie Maples, the hospital’s corporate director of strategic renewal and capital assets, has little faith in the Burrard building in the event of an earthquake. It’s not impossible that it could collapse, crushing the emergency department within.

“The centre block has virtually no lateral resistance ... certain elements will definitely fall off the building. Whether it actually does pancake down, it would have to be a fairly sustained earthquake. But there would be sufficient structural damage that you would have to tear the building down,” said Maples, an architect by training.

That would render the hospital – which handles 20 per cent of Vancouver Coastal Health’s acute care and emergency volume – useless in a crisis. The report states bluntly: “Should a major disaster, electrical or other infrastructure failure take [St. Paul’s] out of service, core health services in Vancouver would be in chaos.” Especially if bridges go.

As she talks about seismic risk, Maples leads a tour through the bowels of the old building, into low-lit basement corridors a century old. Ancient pipes run overhead; at one junction a rusted paint can hangs from the ceiling catching leaks.

Down the hall, an antique claw-foot tub catches water from pipe tests. The fluorescent light and sickly green paint make the area look disturbingly like a setting for a horror movie. One half expects a body.

“This looks like a scene out of a Frankenstein movie or something, but they actually use the tub for testing pumps,” Maples explained. Next to it is a door to the decommissioned boiler room, where water leaks in from outside in big pools on the floor, mould clings to corners and a sign on the door reads: “Danger: Asbestos. Cancer and lung disease hazard.”

These grim conditions aren’t confined underground.

On the first floor of the sunny Comox building next door, Maples stands in a cavernous space now used as a makeshift office-furniture morgue. She points to a crumbling pillar made of clay tiles and mortar – a nightmare to renovate and so brittle that in the event of an earthquake, it is expected to shatter. To underscore her point, Maples whips off her high-heeled shoe and smacks the wall. Shards go flying.

Compounding St. Paul’s aging infrastructure issues are the cramped quarters. The hospital maintains it doesn’t have room to adequately treat patients, especially as it focuses more on cost-saving outpatient care — it’s seen a 33-per-cent growth in outpatient care in the past five years and a 24-per-cent increase in day surgeries.

Currently, these services are spread among 50 different departments in 19 locations on nine floors. A hospital study found a central location could reduce wait times by 40 per cent.

Meanwhile, the population of the downtown peninsula is projected to rise to 100,000 residents by 2021 (an increase of 61 per cent from 1996), with another 173,000 employees expected to come downtown each work day (up 28 per cent from 1996), not to mention more than a million tourist visits annually.

Within the larger Vancouver Coastal Health area, the population is expected to increase 23 per cent by 2030, with seniors, who generally require more care, accounting for much of the growth.

Doyle wants St. Paul’s to be there for the patients of the future.

“There is an increase in families who are living in the downtown area raising their children … who are expecting [St. Paul’s]to be here for them to deliver excellent care now and into the future,” said Doyle, who had her own three children at St. Paul’s. “In order to sustain excellence into the future,” she added pointedly, “St. Paul’s Hospital needs to be renewed.”

That will take money. And though the St. Paul’s Hospital Foundation will kick in about $50 million raised from private donors, the bulk of the $610-million needed will have to come from the province.

In 2010, then Minister of Health Services Kevin Falcon expressed support for a renewal of St. Paul’s after a previous plan to move the hospital to a new site at False Creek was scrapped following opposition from the public and the Save St. Paul’s Coalition. But that setback cost the hospital valuable time and the government $2.4 million in property taxes on land that in the end wasn’t used.

Recently, the government has committed to spending $2.3 billion on capital health-care investment over the next three years and — like a patient in triage — St. Paul’s is desperate to get to the top of the wait list.

Doyle said there have been productive talks, but no promises.

“We’ve had a series of meetings with the members of various sectors within the government. Every signal has been for us to continue with an expectation that renewal will happen, but at this point, we don’t have an approved project,” Doyle said.

When asked about a timeline for St. Paul’s, the office of current Minister of Health Services Mike de Jong played coy, stressing they’ve invested $90 million in upgrades for St. Paul’s since 2001.

“We are currently weighing our capital priorities, including St. Paul’s Hospital, against the government’s other capital priorities before we can make any further comment,” the Ministry said in a statement. “However, we want to reaffirm that this project is a priority for our government.”

Save St. Paul’s Coalition spokesman Brent Granby, who’s been working with the group since 2005, said investment in the hospital is a key concern for West End residents and he argues it will save the province money in the long run.

“Having St. Paul’s so close gives people in the downtown peninsula a lot of comfort,” Granby said.

“I see St. Paul’s as being really central to urban health. One of the great things about the new plan is they’re putting an emphasis … on ambulatory care, increasing their capacity to treat people as outpatients, which is way more cost-effective. I think it’s really critical they invest in the hospital now.”

While they wait, Doyle focuses on what St. Paul’s staff strive for, no matter the conditions they work in: compassionate care.

She recounts stories of staff who have gone the extra mile to accommodate weddings in intensive care units and to organize memorial services for families in the hospital. And she tells of patients who come back years after life-saving procedures to thank doctors and staff.

“We have hundreds of stories like that,” she said. “There truly is that commitment to a holistic approach, seeing people not as a patient with a disease entity, but seeing somebody as an individual who has a life history … It’s a privilege for us to interact with people at these vulnerable times in their life. I think of it personally like a sacred trust.”

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